Healthcare Provider Details

I. General information

NPI: 1922955848
Provider Name (Legal Business Name): CLINTON ADAM ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 KINGDOM WAY STE 100
RALEIGH NC
27607-6063
US

IV. Provider business mailing address

110 EAGLE FORK DR
WAYNESVILLE NC
28786-8121
US

V. Phone/Fax

Practice location:
  • Phone: 828-335-1379
  • Fax:
Mailing address:
  • Phone: 828-335-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: